<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Title</title>
</head>
<body>
<table width="100%" align="center" border="0" cellpadding="0" cellspacing="0">
    <tr bgcolor="#EBEBEB">
        <td width="15"><img src="res/img/28.gif" width="10" height="10"></td>
        <td align="left">我要改号</td>
    </tr>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">挂号单编号</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
        <td bgcolor="#C3DAF2" align="center" width="25%">就诊卡号</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
    </tr>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">姓名</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
        <td bgcolor="#C3DAF2" align="center" width="25%">性别</td>
        <td width="25%">
            <input name="n" type="radio" class="input">男
            <input name="n" type="radio" class="input">女
        </td>
    </tr>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">挂号单编号</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
        <td bgcolor="#C3DAF2" align="center" width="25%">门诊类型</td>
        <td width="25%">
            <select name="select">
                <option>普通门诊</option>
                <option>特需门诊</option>
                <option>专家门诊</option>
            </select>
        </td>
    </tr>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">挂号科室</td>
        <td width="25%">
            <select name="select">
                <option>内科</option>
                <option>外科</option>
                <option selected="selected">儿科</option>
                <option>妇产科</option>
                <option>骨科</option>
                <option>眼科</option>
                <option>口腔科</option>
                <option>五官科</option>
                <option>肿瘤科</option>
                <option>皮肤病科</option>
                <option>中医科</option>
            </select>
        </td>
        <td bgcolor="#C3DAF2" align="center" width="25%">挂号类型</td>
        <td width="25%">
            <select name="select">
                <option>普通挂号</option>
                <option>快速挂号</option>
                <option selected="selected">专家教授</option>
                <option>急诊挂号</option>
                <option>简单挂号</option>
            </select>
        </td>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">就诊医生</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
        <td bgcolor="#C3DAF2" align="center" width="25%">挂号时间</td>
        <td width="25%"><input name="t1" type="text" class="input"></td>
    </tr>
</table>
<br>
<table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
    <tr>
        <td bgcolor="#C3DAF2" align="center" width="25%" height="20">操作人员</td>
        <td width="75%"><input name="t1" type="text" class="input"></td>
    </tr>
</table>
<br>
<table width="95%" border="0" align="center" cellpadding="0" cellspacing="0">
    <tr>
        <td align="center"><input name="submit" type="button" class="buttonface" value="  修改  " onClick="window.location.href='P_infor.jsp'">
    </tr>
</table>
</body>
</html>